NPI | 1306230008 |
---|---|
Entity Type | Organization |
Authorized Contact | ROXANN JEAN HACKBARTH A RN P 712-338-6911 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IA G-092068) |
Enumeration Date | 2015-03-20 |
Last Update Date | 2015-03-20 |